Correlation of salivary and nasal lavage pepsin with MII‐pH testing. (22nd July 2019)

• Record Type: Journal Article
• Authors: Klimara, Miles J.; Johnston, Nikki; Samuels, Tina L.; Visotcky, Alexis M.; Poetker, David M.; Loehrl, Todd A.; Blumin, Joel H.; Bock, Jonathan M.
• Is Part Of: Laryngoscope. Volume 130:Number 4(2020)
• Page Start: 961
• Page End: 966
• Publication Date: 2019-07-22
• Subjects: Laryngopharyngeal reflux -- pepsin -- saliva -- multichannel intraluminal impedance‐pH monitoring; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.28182
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives: Laryngopharyngeal reflux (LPR) is a common upper airway disease. Salivary pepsin is a proposed marker for LPR; however, the optimal time for collection of specimens for pepsin detection and pepsin's presence in the oral and nasal secretions relative to concurrent multichannel intraluminal impedance‐pH (MII‐pH) monitoring are unknown. Study Design: Prospective case‐control study with an experimental design. Methods: Patients undergoing MII‐pH testing for evaluation of LPR and asymptomatic control subjects were selected. Nasal lavage and saliva samples were collected in the clinic prior to MII‐pH probe placement. Additional saliva samples were obtained an hour after each meal and upon waking the following morning. Nasal lavage and salivary pepsin were measured by ELISA. Results: Twenty‐six patients undergoing MII‐pH testing and 13 reflux‐free control patients were enrolled. Salivary pepsin was detected in 11 of 26 patients with suspected LPR and 0 of 13 controls. Pepsin was most frequently detected in the specimen provided upon waking at an average concentration of 186.9 ng/mL. A significant correlation was observed between salivary pepsin in waking samples to MII‐pH measurements, including reflux bolus duration, and proximal and distal recumbent reflux episodes ( P < 0.05). A significant correlation was also observed between salivary pepsin upon waking or sinus lavage and reflux symptom index ( P < 0.05). Conclusion: Pepsin in salivary and nasal lavage samples demonstrated an association with MII‐pH‐documented LPR. Pepsin detection was most frequent in morning samples, supporting use of morning salivary pepsin levels as a potential noninvasive technique for LPR diagnosis. Level of Evidence: 2 Laryngoscope, 130:961–966, 2020